HomeMy WebLinkAbout113664 JORDAN'S TREE MOVING & MAINTENANCE INC - INSURANCE CERTIFICATE (7)OP ID: SLS
IYc�RO DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 02/23/2017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
CONTACT
PRODUCER Phone: 970-223-1804 NAME:
Front Range Insurance Group PHONE FAX
1100 Haxton Drive Suite 100 Fax: A/c No Ext : A/C No):
Fort Collins, CO 80525 E-MAIL
ADDRESS:
David A. Wooldridge LUTCFAAI PRODUCER JORDA-2
rno—M . e.
INSURER(SI AFFORDING COVERAGE NAIC A _
INSURED Jordan's Tree INSURERA: Secure Insurance Companies 22543
Moving & Maintenance, Inc INSURER B: Pinnacol Assurance 41190
1025 Smithfield Drive
Fort Collins, CO 80524 INSURERC:
INSURER D :
INSURER E :
INSURER F :
r'n\/FRArFC rFRTIFIrATF NIIMRFR• REVISION NUMBER'
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
OF INSURANCE
ADDTYPE
I L
POLICY NUMBER
MM DD/YY YY
MM DD/YYYY
LIMITS
A
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FxI OCCUR
X Prof Liab
X
CP003250287-3
CP003260287-3
12/19l2016
12/19/2016
12/19/2017
12/19/2017
EACH OCCURRENCE
$ 1,000,00
DAMAGE TO HEN ED
PREMISES Ea occurrence
$ 300,00
MED EXP (Any one person)
$ 10,00
PERSONAL BADV INJURY
$ 1,000,00
GENERAL AGGREGATE
$ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER.
JrCT POLICY X PRO LOC
PRODUCTS - COMP/OP AGG
$ 2,000,00
Prof Liab
$ 1,000,00
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNEDAUTOS
X
A3200288
12/19/2016
12/19/2017
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,00
X
BODILY INJURY (Per person)
$ 5,00
X
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
X
X
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
EACH OCCURRENCE
$
HCLAIMS-MADE
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVEYIN
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
4040726
03/01/2017
03/01/2018
X I WC STATU- OTH-
T CRYLIMIT ER
E.L. EACH ACCIDENT
$ 1,000,00
E.L. DISEASE - EA EMPLOYE
$ 1,000,00
E.L. DISEASE - POLICY LIMIT
1 $ 1,000,00
A
Equipment Floater
34UUNSR3887
12/19/2016
12/19/2017
Leased 250,00
Ded 50
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
The City of Fort Collins, its officers, agents and employees are named as
additional insured with regards to general and auto Liability.
rc0T1r1r'AT0 unl n=o RANrFI I ATION
CITY OF
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins
ACCORDANCE WITH THE POLICY PROVISIONS.
Puchasing Dept.
PO BOX 580
Fort Collins, CO 80522
AUTHORIZED REPRESENTATIVE
V lUt$U-ZUUtIAI.uKLIL,UKI'L)KAI IL)N. All rlgnis reserve0.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD